Provider Demographics
NPI:1225380611
Name:SHAW, CARLIE
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 W 3RD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2236
Mailing Address - Country:US
Mailing Address - Phone:907-279-9634
Mailing Address - Fax:907-276-5489
Practice Address - Street 1:509 W 3RD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2236
Practice Address - Country:US
Practice Address - Phone:907-279-9634
Practice Address - Fax:907-276-5489
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist